Mitral Regurgitation Flashcards
what are the problems of leaflets causing mitral regurgitation ?4
- prolapse
- rheumatic
- myxomatous
- endocarditis - relatively common
what is prolapse normally due to
usually due to chordal rupture. You can get congenital rupture
what causes a floppy (myxomatous) valve?
probably degenerative. You get a thickened, billowing mitral valve - barlow’s valve
what are the other causes of MR?
chordae rupture
- papillary muscle rupture
- annular dilatation
what can cause papillary muscle rupture?
ischaemia
papillary muscle rupture can cause ________
severe pulmonary oedema
most patients with heart failure have some form of ______
annular dilatation
Regurgitation into the left atrium produces ___ _______.
Regurgitation into the left atrium produces LA dilatation.
with acute mitral regurgitation the normal compliance of the left atrium does not allow much _______ and the left atrial pressure ____
with acute mitral regurgitation the normal compliance of the left atrium does not allow much dilatation and the left atrial pressure rises
Pulmonary venous pressure can rise and produce _____ ______
Pulmonary venous pressure can rise and produce pulmonary oedema
what are the symptoms?
- breathlessness
- peripheral oedema
- fatigue
- CCF
why breathlessness?
pulmonary venous hypertension
why peripheral oedema?
patients can develop RHF due to back pressure effects
why fatigue?
due to reduced CO
what happens to the apex beat?
displaced diffuse - get cardiomegaly
what can be felt on examination if MR is severe?
systolic thrill
what is the first heart sound like?
soft
what kind of murmur may be heard?
pansystolic murmur
where does the murmur radiate to ?
the axilla
what is the other sound heard?
prominent 3rd heart sound
why is there a prominent 3rd heart sound
owing to the sudden rush of blood back to the dilated left ventricle in early-mid diastole
what is the most common cause of MR?
functional with HF
what is the treatment for MR in HF?
treat the HF aggressively
what medication may be given?
diuretics and ACEi (HF)
what surgical treatment options are there?
repair
replacement
when is repair done?
if there is not much calcification
which group do not get surgery ?
people with heart failure
what can be done percutaneously ?
clips in infancy
what is a prolapsing mitral valve called?
barlow’s syndrome or floppy mitral valve
why is the valve floppy ?
- excessively large mitral valve leaflets,
- an enlarged mitral annulus,
- abnormally long chordae or
- disordered papillary muscle contraction.
what are the causes of barlow’s ?
- marfans,
- thyrotoxicosis,
- rheumatic or
- ischaemic heart disease
- also occurs with ASD and as part of HCm
what are the symptoms of barlow’s ?
- atypical chest pain - sub mammar. Sometimes it is substantial, aching and severe
- palpitations - may occur
what are the signs of barlow’s ?
mid-systolic click
why is there a mid systolic click in barlow’s
produced by the sudden prolapse of the valve and the tensing of the chordae tendinae that occurs during systole
what is the treatment for barlow’s
beta -blockade is effective for the chest pain and palpitations
